Understanding the process of linking insurance payments to claims is essential for effectively managing healthcare reimbursements. When an insurance carrier issues a payment on a claim, they provide an Explanation of Benefits (EOB) along with the payment. Additionally, an EOB may be sent even when the carrier is not making a payment on the claim. It is important to properly connect these payments to claims in order to allocate funds to specific codes. However, this process can become more complex when the payment amount is zero.
Explore this video for an in-depth walkthrough.
A zero-dollar insurance payment takes place in any one of the scenarios given below.
- Contractual Adjustments: The insurance company may apply adjustments based on pre-negotiated rates with the provider, which leads to zero reimbursement after the adjustment.
- Patient Responsibility: The claim amount might be transferred to the patient’s responsibility, such as a deductible or copay, leading to no payment by the insurer.
- Claim Denial or Reduction: A zero-dollar payment may indicate that the claim was denied, reduced, or deemed non-payable due to factors like missing information, non-covered services, or policy exclusions.
- Coordination of Benefits: If another insurer is deemed primary, the secondary insurer may mark the payment as zero until it is billed to the correct payer.
- Documentation Requirement: Sometimes, the insurance company withholds payment until further documentation is received, issuing a zero-dollar claim as a placeholder.
Let's get started.
- Navigate to the System Menu > select Insurance Payments.
Navigate to the top right and select Add Insurance Payment.
Select the Carrier from the drop-down list.
- Enter the Payment Amount.
- Follow your practice’s policies for entering details for the Location, Payment Dates, Deposit Date, Payment Type, Remarks and Insurance Payment Flags.
- Click Add Receipt and Apply.
Tip: As you start typing the Carrier, the system will narrow down your list in the drop-down. |
Find your Patient Claim using the Search Patient toolbar on the top left and choose Add Line Level Payment.
- Enter the Patient and Insurance Responsibility as described in the EOB. You need to enter the details in all three fields for all the codes in the claim.
- The system will apply the needed adjustments and transfers depending on the responsibility compared to the Allowed Amount on the claim.
- To post a zero-dollar transaction, enter a value of $0.00 either at the line level or the claim level.
- Until a $0.00 insurance payment is entered, the Post Zero Dollar Transactions checkbox will remain greyed out.
- Select the Post $ 0.00 Transactions checkbox.
- Click Submit.
- Navigate to the Insurance Payments slide - out with the receipt tiles.
- Locate the Payment and click Mark as Posted to move it to the Posted section.
Practices can use this guide to gain a clear understanding of Zero Dollar Insurance Payments.